急性硬脊膜外血肿的诊治

目的 研究急性硬脊膜外血肿的原因、临床表现、影像学特点及治疗方法。方法 对10a来经手术治疗的32例急性硬脊膜外血肿的病因、临床表现、MRI、DSA检查情况、手术治疗和随访结果进行分析。结果 32例病人中有26例直接手术清除血肿；6例先栓塞硬脊膜动静脉瘘（AVF）的供血动脉后，再手术清除血肿并切除瘘口。随访2－9a。神经系统恢复到正常情况11例；有轻度神经系统改变但生活可以自理15例；需他人帮助者4例；2例因血肿压迫时间，术后双下肢瘫痪及尿留渚留未改善；本组无死亡。结论 急性硬脊膜外血肿的早期诊断和治疗是提高疗效的关键。脊髓MRI检查是诊断急性硬脊膜外血肿的首选方法，清除血肿减轻其对脊髓的压迫是治疗本病的唯一有效方法、大的、高血流量的AVF术前栓塞供血动脉可减少术中出血。

Diagnosis and treatment of acute spinal epidural hematoma

Objective This retrospective study was performed to research clinical feature,the use of MRI and DSA in 32 patients with acute spinal epidural hematoma and to evaluate the result of operation.Method The authors studied 32 patients with acute spinal epidural hematoma who underwent surgical treatment.Twenty of these patients underwent DSA and found 18 patients with perimedullary arteriovenous fistulas(AVFs).All patients underwent surgery and six patients underwent surgery combined with adjuvant preoperative embolization.Result Postoperatively neurological status was recovered in 11 patients and improved in 15 patients,with others helped in 4 patients,and unchanged in 2 patients.Conclusion Early diagnosis and surgical treatment of acute spinal epidural hematoma is the key to get satisfactory result.For large and high-flow AVFs,embolization proved to be a useful adjunct to surgery MRI findings were useful in establishing the diagnosis of acute spinal epidural hematoma.